[Psychometric properties of the Hospital Ethical Climate Survey: a cross-sectional study among Belgian psychiatric...

The task of caring for psychiatric patients is so complex that it often leads to ethical dilemmas. The ethical climate on a ward is a crucial factor. This is the first study about the ethical climate in mental healthcare.

To investigate whether the only instrument currently available for measuring the ethical climate in general hospitals, namely the 'Hospital Ethical Climate Survey' (HECS), is a reliable and valid instrument for use on psychiatric wards.

A cross-sectional study was performed in a psychiatric hospital in Belgium. All 320 nurses were invited to participate (response rate = 265). The factor structure of the HECS was examined by means of explorative principal component analysis (PCA) and confirmatory factor analysis (CFA). The reliability of the constructed scale and subscales was investigated.

Five factors were identified. The structure of these factors in the translated list was almost identical to the structure obtained with the original instrument and its underlying theoretical basis. Items relating to several other allied healthcare professions were added. This addition widened the subscale 'relationship with physician' so that it included 'relationship with other disciplines' (medical and allied healthcare workers).

The reliability of the instrument appeared to be good and yielded scores comparable to those obtained as a result of earlier research performed in general hospitals. The setting for our investigation produced a significantly higher main score for the ethical climate than did previous studies.